{"id":338587,"url":"https://alion.io/job/enablecomp-drg-validatorreviewer-remote","title":"DRG Validator/Reviewer (REMOTE)","company":{"id":4046,"name":"EnableComp","domain":"enablecomp.com","url":"https://alion.io/company/enablecomp","size_band":"501-1000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Lever","truth_index":null},"role":"HR","role_family":"HR","seniority":"junior","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Franklin, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":45000,"max_usd":93000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":643},"experience_years_min":2,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Human-in-the-Loop","optional":false},{"name":"Microsoft Office","optional":false},{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-07-28T13:28:13Z","employer_posted_date":"2026-07-28","last_verified_at":"2026-09-27T23:47:15Z","board_verified":true,"closed_at":null,"days_open":61,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":61},"description":"EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.\nPosition Summary\nThe DRG Validator/Reviewer is responsible for reviewing post-billed inpatient claims to identify and validate missed reimbursement opportunities based on diagnosis and procedure coding. Working within a specialized DRG (Diagnosis-Related Group) database, DRG Reviewers utilize their technical expertise in ICD-10 coding to analyze medical records, determine coding accuracy, and make recommendations that optimize hospital reimbursement. This role requires certification as a Certified Coding Specialist (CCS) and a deep understanding of medical record documentation, clinical coding guidelines, and DRG reimbursement methodology. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.\nKey Responsibilities\nReview inpatient claims imported into the DRG database, focusing on diagnosis, procedures, grouping logic, and reimbursement accuracy.\nAnalyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.\nConduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.\nNavigate medical records efficiently, targeting specific sections (e.g., discharge summary, operative reports) based on system edits and flagged items.\nMatch clinical documentation in the medical record to corresponding ICD-10 codes, ensuring DRG accuracy.\nIdentify and correct errors such as under coded or misclassified diagnoses and procedures.\nUtilize Health ROI system edits to detect specific high-value opportunities (e.g., dialysis, occlusion, embolization, catheterization).\nMake reimbursement improvement recommendations and submit findings for client review and approval.\nCollaborate with leadership on case prioritization and workflow management.\nStay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.\nAnalyze client reporting.\nIdentify new revenue opportunities related to all inpatient DRG related components.\nOther duties as required.\nRequirements and Qualifications\nAssociate's or bachelor’s degree in health information management or related field required. (RHIT or RHIA credentialed individuals encouraged).\nCertified Coding Specialist (CCS) certification required.\n2-3 years’ experience in DRG validation, inpatient medical coding, or related coding review.\nStrong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.\nProficient in reading and interpreting clinical documentation across multiple departments (e.g., nursing, operative, radiology, pharmacy).\nExperience working in a post-bill coding environment and familiarity with DRG grouping software and billing databases.\nAnalytical thinker with a focus on financial impact and reimbursement accuracy.\nComfortable navigating multiple digital platforms, EMRs, and data systems.\nMust have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).\nTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.\nSpecial Considerations and Prerequisites\nThis role is primarily office-based or remote, depending on company policy, with extensive computer and document review work.\nMust be comfortable working independently in a detail-oriented, data-driven environment.\nExcellent communication and documentation skills to support client reporting and recommendations.\nHigh integrity and professionalism in handling PHI and confidential information.\nStrong collaboration and responsiveness to feedback from leadership and client partners.\nAbility to review and analyze large volumes of medical and billing data.\nStrong focus and attention to detail in identifying discrepancies and ensuring compliance.\nAbility to manage high volumes of case processing with accuracy and efficiency.\nAbility to meet deadlines and handle time-sensitive workloads in a high-volume environment.\nProven written and verbal communication skills.\nStrong analytical and problem-solving skills.\nAbility to prioritize and manage multiple competing priorities and projects concurrently.\nProven experience working with external clients; strong customer service skills and business acumen.\nTimely and regular attendance.","description_format":"text","description_chars":5816,"description_truncated":false,"requirements":{"experience_years_min":2,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":[],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Business Process Outsourcing (BPO)","Revenue Cycle & Medical Billing"],"lifecycle":[{"event":"open","at":"2026-09-05T17:55:42Z"}],"liveness":{"score":8,"band":"cold","label":"Long shot","p_open":1,"p_active":0.284,"p_room":0.28,"age_days":60,"expected_fill_days":20,"reasons":["conf:0","win:tail","crowd:junior"],"computed_at":"2026-09-27T05:45:00Z"},"pay":null,"html_url":"https://alion.io/job/enablecomp-drg-validatorreviewer-remote","json_url":"https://alion.io/job/enablecomp-drg-validatorreviewer-remote.json","meta":{"generated_at":"2026-09-28T03:33:32Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","usage":{"tier":"crawler","counted_by":"address","units_charged":1,"used_today":2258,"day_limit":5000,"remaining_today":2742,"minute_limit":60,"resets_at":"2026-09-29T00:00:00Z"}}}